Early Specialist Research Articles

At a glance: pressure injuries.

Pressure injuries, also known as pressure ulcers or 'bed sores', are caused by prolonged pressure on the skin and underlying tissues and are common in healthcare settings. They result from a variety of factors including pressure, moisture and friction, with a higher risk among older adults, post‑surgical patients and those with limited mobility or long‑term conditions. These injuries can extend hospital stays and significantly impact patient recovery and mortality risk. Prevention includes regular repositioning, the use of pressure‑relieving devices, skin care and nutritional support. The National Institute for Health and Care Excellence provides guidelines to mitigate these risks through systematic risk assessments and targeted interventions. Early detection and specialist care by a multidisciplinary team are crucial to improving patient outcomes. Consistent pplication of prevention strategies are needed to reduce incidence, improve patient care and alleviate the economic burden of thesex injuries on the NHS.

Influences of Specialist Palliative Care Team Input, Advance Care Planning, Non-Invasive Ventilation and Gastrostomy Status on Unscheduled Hospital Admissions and Place of Death for People with Motor Neuron Disease: A Retrospective Cohort Analysis.

Motor neuron disease is a rapidly progressing neurological condition. People with life-limiting conditions generally prefer to die at home and avoid hospital admissions, with Specialist Palliative Care Team involvement often pivotal. Our aim was to investigate the role of advance care planning, Specialist Palliative Care Team input and other relevant variables on place of death and unscheduled hospital admissions in a Scottish population of people with motor neuron disease. Methods: National CARE-MND audit data, primary and secondary care data, and local Palliative Care records were interrogated. Chi-square, point-biserial correlation and binary logistic regression analysed associations (p < 0.05 statistically significant). Participants (188) were deceased, having a verified motor neuron disease diagnosis between 2015-2017, diagnosis occurring ≥28 days before death. Results: Advance care planning and Specialist Palliative Care Team input of ≥28 days were associated with increased odds of dying outside hospital (BLR:OR 3.937, CI 1.558-9.948, p = 0.004 and OR 2.657, CI 1.135-6.222, p = 0.024 respectively). Non-invasive ventilation decreased the odds of dying outside hospital (BLR:OR 0.311, CI 0.124-0.781, p = 0.013). Having a gastrostomy increased odds of ≥1 admissions in the last year of life (BLR:OR 5.142, CI 1.715-15.417, p = 0.003). Statistical significance was retained with removal of gastrostomy-related complications. Conclusion: Early Specialist Palliative Care input and advance care planning may increase the likelihood of death outside of hospital for persons with motor neuron disease. Further research is warranted into barriers of facilitating death outside of hospital with home non-invasive ventilation use and the association between gastrostomy status and unscheduled admissions.

Outcome Measures And Analysis Of Memory Movers- An Exercise Programme For The Brain, Body And Mind

Abstract Background Memory Movers is a six-week early intervention specialist programme designed for implementation in community settings to meet key healthcare needs for individuals experiencing memory difficulties/dementia and their family carers. This programme provides individuals with the knowledge, skills and education to care for their overall health and well-being. It supports mental health and well-being by utilising cognitive stimulation exercises in conjunction with physical health exercises and providing information and basic exercises in mental health. Methods The Specialist Mental Health Service for Older People collaborated with an Acute Hospital, local Council, and Sports and Wellbeing Partnership in designing a suitable, accessible programme to promote Mental Health and well-being in the community. The programme incorporates the following aspects of health: Memory, Movement, and Mental Health. Results Pre- and post-assessments were undertaken with results highlighting the following: The Life Satisfaction Scale improved by 6%; the Mood Rating Scale improved by 19% and the overall rating of experiencing feelings of anxiety was reduced by 14% within the final week. There was also a 101% increase in the average engagement in physical activity. A range of positive comments received from attendees were recorded on feedback questionnaires. Conclusion Findings highlighted that remaining active supports both physical and mental health. According to the HSE (2020), physical exercise can cause chemical changes in the brain, which can help improve mood. Cognitive stimulation is beneficial to brain health and cognition (Schulz 2015). These contribute to the overall well-being of individuals, promoting cognitive functioning and movement, as well as overall mental health and well-being. This programme also provides opportunities for social connection and integration with services.

Peer mentor contributions to an early intervention vocational rehabilitation specialist service following trauma: A qualitative study

BackgroundPeer mentors have a role in facilitating the participation, health and well-being of people who have had a traumatic injury. Few studies have explored the involvement of peer mentors in an early intervention vocational rehabilitation (EIVR) service following trauma. ObjectiveThis study aimed to explore the experience of implementing peer support within the context of an EIVR service from the perspectives of the peer mentors themselves, the vocational therapists supervising them, and the patients that received peer mentoring. MethodsSemi-structured interviews were conducted with twenty participants from three groups: peer mentors (n = 4); vocational therapists (n = 3); and patients who received the EIVR intervention (n = 24). Data were thematically analysed. ResultsThree themes were identified: The value of peer input in an EIVR service, The facilitators impacting the value of peer involvement as part of the EIVR service, The challenges impacting peer input as part of an EIVR service. ConclusionsThe inclusion of peer mentors early after major traumatic injury was a unique and valuable addition to the EIVR service. Offering peer support early on in rehabilitation enabled patients to gain a sense of hope for their future, and the expectation that returning to work was a realistic option. The careful selection of peer mentors, and ensuring they receive adequate preparation and ongoing supervision are vital to support their well-being during the intervention. Aiming to match peer mentors with similar injuries and work backgrounds to patients is an important contributor to the likely ongoing engagement of the mentee with the mentor.

The experience of occupational therapists and physiotherapists using a prototype, evidence-informed online knowledge translation resource to learn about patient-defined, personally-meaningful chronic pain rehabilitation.

Chronic pain is a complex biopsychosocial experience, and rehabilitation helps people to manage pain, and restore valued life roles. Evidence suggests that more positive outcomes occur when clients perceive their rehabilitation to be meaningful. People with chronic pain describe rehabilitation as personally-meaningful when they develop a genuine connection with a credible therapist who they see as a guiding partner, and when rehabilitation holds personal value, is self-defined, and relevant to their sense of self-identity. This paper presents a qualitative study of therapists' experience using an e-learning package on patient-defined, personally-meaningful rehabilitation. A qualitative descriptive design was used to explore rehabilitation therapists' experience of a prototype evidence-informed, online resource developed on the basis of eLearning and web-design principles. Semi-structured interviews and focus groups were conducted with a purposive sample of occupational therapists and physiotherapists, and inductive coding and thematic analysis of transcripts was completed. Twenty-four therapists (12 occupational therapists, 12 physiotherapists) participated, representing a mix of gender and experience (early career; experienced; and specialist). Four themes and 12 sub-themes emerged from the analysis. The resource delivered a positive user experience, which added (translational) value to enhance learning, and participants were highly positive about the future potential of the resource to translate chronic pain rehabilitation research for early career, experienced, and specialist rehabilitation therapists. Results suggest that the disparate learning needs of rehabilitation therapists from diverse professional backgrounds and experience, may be addressed through the one resource. Participant feedback provides evidence that the resource fits with current models of learning and behaviour change. This study demonstrates the importance of basing online resources on eLearning and web-design principles to translate complex biopsychosocial chronic pain rehabilitation research for rehabilitation therapists.

Sociological analysis of the functioning of early assistance services for children under 3 years in the Krasnoyarsk Krai

The purpose of the study is a comprehensive sociological analysis of the functioning of early intervention services for children under 3 years of age in the Krasnoyarsk Territory. The tasks of the analysis include: 1) studying the structure of the early intervention service as a social organization, the functions of its elements, systemic connections and relationships between them; 2) studying the satisfaction of representatives of client families with the work of early intervention services; 3) studying the subjective perceptions of employees of early intervention services and representative’s client families about the content and meaning of the services. The authors used the methods of a sociological survey, in-depth interviews, participant observation. Based on a number of indicators, the authors concluded that early intervention services were predominantly highly effective. The article shows the problem area of the functioning of early intervention services, which lies in the difference in understanding the goals and results of working with children on the part of client families and early intervention service specialists. Specialists see as the main goal the development of functional skills by children that contribute to socialization and independence, and then the improvement, the acquisition of educational, cognitive skills. Parents often prioritize learning skills when setting class goals. This difference may reduce parental satisfaction with the results of early intervention and the effectiveness of classes. The authors revealed the dependence of the level of involvement of parents in work with children together with specialists from early intervention services on the length of service and the age of the child. The more experience and the older the child, the less parents are involved in working with children. The authors proposed a social typology of representatives of client families on the grounds of their involvement in work with children and their attitude to the results of work with a child.

The development of inherited cardiac conditions services: current position and future perspectives.

Over the last two decades, inherited cardiac conditions (ICC) centres have emerged with the aim of improving outcomes for patients and their families, through early diagnosis, genetic testing, risk assessment and specialist treatment. A literature search was performed using PubMed (https://pubmed.ncbi.nlm.nih.gov/). Commissioned ICC service reviews from NHS England, NHS Improvement and PHG Foundation were evaluated. ICC patient management requires a multi-disciplinary approach. ICC services are predominantly based within tertiary centres. Despite expansion, provision of care remains inadequate to meet rising demands. Access to services is inconsistent, partly due to geographic variation and lack of standardized pathways. The optimal ICC care model remains undecided, although there is growing interest in 'hub-and-spoke' networks, which could aid secondary and tertiary service integration and repatriation of care. Genetic mainstreaming is a priority for the Genomic Medicine Service Alliance. The benefits of telehealth and virtual clinics have been validated by their use during the COVID-19 pandemic. Other innovations to improve resource efficiency, such as clinical scientist-led and nurse-led clinics, show promise. An update for the NHS ICC service specifications is planned that appears well timed given the rapid evolution of the ICC landscape in the decade since last review. This has the potential to address needs including national audit, standardized pathways and ICC networks to improve governance and equity of care. Delegation of commissioning for specialist services to integrated care systems may also provide opportunity for increased regional direction.

Investigating the effects of frailty on six-month outcomes in older trauma patients admitted to UK major trauma centres: a multi-centre follow up study

BackgroundPre-injury frailty is associated with adverse in-hospital outcomes in older trauma patients, but the association with longer term survival and recovery is unclear. We aimed to investigate post discharge survival and health-related quality of life (HRQoL) in older frail patients at six months after Major Trauma Centre (MTC) admission.MethodsThis was a multi-centre study of patients aged ≥ 65 years admitted to five MTCs. Data were collected via questionnaire at hospital discharge and six months later. The primary outcome was patient-reported HRQoL at follow up using Euroqol EQ5D-5 L visual analogue scale (VAS). Secondary outcomes included health status according to EQ5D dimensions and care requirements at follow up. Multivariable linear regression analysis was conducted to evaluate the association between predictor variables and EQ-5D-5 L VAS at follow up.ResultsFifty-four patients died in the follow up period, of which two-third (64%) had been categorised as frail pre-injury, compared to 21 (16%) of the 133 survivors. There was no difference in self-reported HRQoL between frail and not-frail patients at discharge (Mean EQ-VAS: Frail 55.8 vs. Not-frail 64.1, p = 0.137) however at follow-up HRQoL had improved for the not-frail group but deteriorated for frail patients (Mean EQ-VAS: Frail: 50.0 vs. Not-frail: 65.8, p = 0.009). There was a two-fold increase in poor quality of life at six months (VAS ≤ 50) for frail patients (Frail: 65% vs. Not-frail: 30% p < 0.009). Frailty (β-13.741 [95% CI -25.377, 2.105], p = 0.02), increased age (β -1.064 [95% CI [-1.705, -0.423] p = 0.00) and non-home discharge (β -12.017 [95% CI [118.403, 207.203], p = 0.04) were associated with worse HRQoL at follow up. Requirements for professional carers increased five-fold in frail patients at follow-up (Frail: 25% vs. Not-frail: 4%, p = 0.01).ConclusionsFrailty is associated with increased mortality post trauma discharge and frail older trauma survivors had worse HRQoL and increased care needs at six months post-discharge. Pre-injury frailty is a predictor of poor longer-term HRQoL after trauma and recognition should enable early specialist pathways and discharge planning.

Benchmarking Time-to-Treatment Initiation in Sarcoma Care Using Real-World-Time Data.

Benchmarking is a fundamental tool for enhancing quality within a patient-centered healthcare framework. This study presents an analysis of time-to-treatment initiation (TTI) for sarcoma patients, utilizing a database encompassing 266 cases from the Swiss Sarcoma Network. Our findings indicate a median TTI of 30 days across the cohort, with bone sarcomas and deep soft tissue sarcomas demonstrating a shorter median TTI of 28 days, followed by superficial soft tissue sarcomas at 42 days. The data reveal that the use of real-world-time data (RWTD) may account for a longer TTI observed, as it offers more comprehensive capture of patient journeys, unlike conventional datasets. Notably, variability in TTI was observed between different treatment institutions, which underscores the need for standardized processes across centers. We advocate for a selective referral system to specialized centers to prevent capacity overload and ensure timely treatment initiation. Our analysis also identified significant delays in TTI for unplanned 'whoops'-resections, highlighting the importance of early specialist referral in optimizing treatment timelines. This study emphasizes the potential benefits of a streamlined, data-informed approach to sarcoma care. However, further research is required to establish the direct impact of integrated care models on TTI and patient outcomes in the context of sarcoma treatment.

Azerbaijani Higher Education to implement mass English Medium Instruction (EMI) policies

In the last decade, Azerbaijani universities’ upward implementation of English-medium instruction (EMI) policy has spread among most of the country's universities, public and private. Students are no longer enthusiastic about getting an education in their native language, neither they see Russian as a medium of instruction that used to be a vehicle for a brighter future. Research suggests that the rapid implementation of EMI policy is primarily motivated by the pursuit of internationalization (Williams, 2023), participation in international projects (Mammadova, 2020), and international academic mobility (Mammadova, 2023). As a result, attributed to the mass abandoning of the country by young early career specialists who have recently graduated from Higher Educational Institutions (HEI), the country annually loses a high number of qualified personnel (see Figure 1) who heavily resort to their linguistic competencies and go after a ‘better life’. Figure 1 demonstrates the average value for Azerbaijan to leave the country during the period between 2015 and 2022. With an average of 4.74 points out of 10, the minimum 4 index point was observed in 2016 and a maximum of 4.4 index points in 2022. In turn, the UN Migrant Stocks (2021) reports that by mid-2020 Azerbaijan had an emigration rate of 10.6 percent of its entire population. According to Chaikhana Media (2022), ‘there's a brain drain in Azerbaijan, highly-skilled people do leave their country even though they have had a high salary in Azerbaijan.’

Advancing early relational health: a collaborative exploration of a research agenda.

Here, we introduce the Early Relational Health (ERH) Learning Community's bold, large-scale, collaborative, data-driven and practice-informed research agenda focused on furthering our mechanistic understanding of ERH and identifying feasible and effective practices for making ERH promotion a routine and integrated component of pediatric primary care. The ERH Learning Community, formed by a team of parent/caregiver leaders, pediatric care clinicians, researchers, and early childhood development specialists, is a workgroup of Nurture Connection-a hub geared toward promoting ERH, i.e., the positive and nurturing relationship between young children and their parent(s)/caregiver(s), in families and communities nationwide. In response to the current child mental health crisis and the American Academy of Pediatrics (AAP) policy statement promoting ERH, the ERH Learning Community held an in-person meeting at the AAP national headquarters in December 2022 where members collaboratively designed an integrated research agenda to advance ERH. This agenda weaves together community partners, clinicians, and academics, melding the principles of participatory engagement and human-centered design, such as early engagement, co-design, iterative feedback, and cultural humility. Here, we present gaps in the ERH literature that prompted this initiative and the co-design activity that led to this novel and iterative community-focused research agenda, with parents/caregivers at the core, and in close collaboration with pediatric clinicians for real-world promotion of ERH in the pediatric primary care setting.

Correction to: Improving Access and Timeliness of Early Palliative Care Specialist Assessment for Patients With Advanced Lung Cancer in a Rapid Assessment Clinic by O'Neill et al. Journal of Palliative Medicine 2023;26(10):1365–1373; doi: 10.1089/jpm.2022.0544

<i>Correction to:</i> Improving Access and Timeliness of Early Palliative Care Specialist Assessment for Patients With Advanced Lung Cancer in a Rapid Assessment Clinic by O'Neill et al. Journal of Palliative Medicine 2023;26(10):1365–1373; doi: 10.1089/jpm.2022.0544

EGS P24 Management of oesophageal denture impaction and complications - a case series

Abstract Background Dentures are sometimes inadvertently ingested and can impact in the oesophagus. This can lead to complications such as mediastinitis, perforation and major vascular fistulae. In 1914, Chiari coined ‘aorto-oesophageal syndrome’ following foreign body ingestion. Usually diagnosed post-mortem, he described a triad of chest pain, haematemesis and cardiac arrest resulting from perforation and aortic fistula. Modern dentures are radiolucent, have complex configurations and commonly impact in the oesophagus at the level of the aortic arch. Early specialist intervention by experienced oesophago-gastric (OG) surgeons is crucial to the prognosis. We present our personal experience of managing oesophageal denture impaction and complications. Methods A retrospective review of electronic health records of the authors’ case series of patients with a diagnosis of oesophageal denture impaction over a 13-year period from 01/01/2010 to 31/12/2022 was performed. The inclusion criteria was adult patients with a clinical diagnosis of oesophageal denture/dental bridge impaction. Pathology and complications from impaction and mode of intervention was reviewed. Other outcome measures evaluated were treatment complications, length of stay and 90-day mortality. Results Seven patients (6 males) with median age 54 were reviewed. Dentures were impacted at or above the aortic arch in 6 patients. Attempted retrieval with ENT rigid scope in 3 caused migration of denture causing perforation. Attempted retrieval with flexible gastroscope was successful in 3 but led to opening up of a fistula in one. Five patients underwent surgical intervention (results summarised in tables 1 and 2). 90-day mortality was 0%. The median length of stay in the surgical intervention group was 30 days. Two patients who had aorto-oesophageal fistulae required additional input by cardiac surgery and vascular radiology teams. Conclusions This is a report of the authors’ experience of managing oesophageal denture impaction and it’s sequelae. A favourable 0% 90-day mortality rate despite complex presentations including aorto-oesophageal fistulae has been described. For patients presenting with haematemesis or prolonged history of denture impaction a triple phase CT scan should be performed prior to intervention. The variable complex configuration of dentures complicates their impaction or attempts at extraction. Attempts at extraction with a rigid endoscope can lead to oesophageal perforation. Successful management of these complex cases requires an effective multidisciplinary approach in a specialist OG surgery centre.

Effect of timing of palliative care consultation on survival and end-of-life care outcomes in mNSCLC.

247 Background: Early specialist palliative care (PC) involvement in metastatic non-small cell lung cancer (mNSCLC) is associated with improved quality of life, less aggressive end of life (EoL) care, and longer survival. However, PC utilization remains low, and treatment paradigms have evolved. We examined how the timing and extent of PC involvement impacted outcomes in patients with mNSCLC in the era of targeted- and immune-therapy. Methods: This retrospective review analyzed patients with mNSCLC who initiated first-line treatment with chemotherapy, immunotherapy, or combined chemoimmunotherapy at Duke University between March 2015 and July 2019 and had at least one PC visit. Data were abstracted through November 2022. Patient outcomes data, including the NCCN Distress Thermometer (DT), survival, and EoL care, were analyzed using descriptive statistics. Aggressive EoL care was defined as any cancer-directed therapy, &gt;1 emergency department visit, &gt;1 hospital admission, or &gt;14 days spent in the hospital in the last 30 days of life; or hospice entry within the last 3 days of life or in-hospital death. To examine associations between PC utilization and timing of PC referral with actionable distress we fit generalized estimating equations. Results: The 60 patients were stratified by time to first PC encounter and total number of PC visits. Average age was 63.6 years, 53% were female, and 60% Caucasian. 32% were seen within 2 months of diagnosis (early), 37% between 2-6 months (moderate), and 32% were seen by PC after 6 months (late). 27% of patients saw outpatient PC only once, 43% between 2-4 times, and 30% saw PC 5 or greater times. There was no evidence of an association between PC utilization and actionable distress (NCCN DT score of 4 or greater) nor with timing of PC referral and actionable distress. Median survival was 15.3 months in the early PC group, 6.2 months in the moderate group, and 17.0 months in the late group, with a median survival of 12.5 months. Patients who received early PC spent more time on hospice (45.5 days) compared to those with moderate (29.6 days) and late (22.5 days) PC. Receipt of aggressive EoL care was high overall; 32% of patients with early PC visits received aggressive EoL care compared to 50% in moderate and 63% in late PC groups. Of the 51 decedents, only 30 (59%) enrolled in hospice. 11% of patients in the early PC group died in the hospital, compared to 14% in the moderate and 21% in the late groups. Conclusions: This real-world study reveals that referrals to PC still occur late in the disease course of mNSCLC, despite proven benefits of early integration. Early PC resulted in longer time on hospice, lower frequency of aggressive EoL care, and lower rates of in-hospital death, with no evidence of decreased survival. These findings suggest that early specialist PC improves outcomes in the era of novel mNSCLC therapies, but that PC remains underutilized, and many unmet needs persist in this population.

Difficulty diagnosing oral cancer: seeking an early specialist opinion is key

Difficulty diagnosing oral cancer: seeking an early specialist opinion is key

BE-A-PAL: Behavioral economics and automated analytics to improve palliative care among patients with advanced cancer.

268 Background: Patients with advanced solid malignancies often experience high symptom burden and aggressive end-of-life care. Early specialist palliative care (PC) can improve symptom management, mood, and quality of life. However, many patients do not receive PC before they die, with clinician inertia and difficulty identifying high-risk patients being barriers to initiating PC referrals. Methods: In a 2-arm pragmatic randomized clinical trial among patients with stage 3 or 4 lung or non-colorectal gastrointestinal malignancies, oncology clinics were randomly assigned to intervention or usual practice. In the intervention arm, oncologists received automated algorithm-based default notifications prompting specialty PC referral. The control arm received usual care, in which oncologists could refer to PC at their discretion. The algorithm was adapted from NCCN guidelines, identified high-risk patients based on prognosis or symptom/psychosocial burden, and was integrated into the EHR. Oncologists were alerted weekly about eligible patients and had the option to opt-out of PC referral. If there was no response or agreement, a PC coordinator introduced and offered a PC visit to the patient. The primary outcome was a completed PC visit within three months of identification among high-risk patients. We report descriptive results from an interim analysis of the trial. Results: 15 practices (7 clinics and 32 physicians in intervention; 8 clinics and 31 physicians in control) and 567 patients (299 intervention; 268 control) were randomized. Rates of completed early PC visits were 46.4% (139/299) the intervention arm and 11.2% (30/268) in the control arm. The opt-out rate in the intervention arm was 10.7%. Among clinicians who did not opt-out, 79% of their patients agreed to an initial PC visit. Adjusted analyses and demographic data will be completed and available by September 2023. Conclusions: Algorithm-based default PC referrals meaningfully increased utilization of specialty PC within a community oncology practice. Targeting high-risk patients using guideline-based risk stratification prevented overwhelming PC capacity. Further analyses will assess the impact of the intervention on end-of-life care, acute care utilization, patient-reported outcomes, and explore clinician perspectives. Clinical trial information: NCT05590962 .

장애통합보육을 실천하는 교사의 어려움과 제도적 방안연구

Objectives The purpose of this study is to identify the challenges of implementing integrated childcare in public childcare centers for infants and toddlers with disabilities and to identify institutional measures to implement integrated childcare.&#x0D; Methods Face-to-face interviews were conducted with three disability childcare teachers working in state-run integrated childcare centers in Seoul and Gyeonggi-do, and non-face-to-face interviews were conducted with three early childhood specialists to collect and analyze the data.&#x0D; Results The difficulties of teachers practicing disability integrated childcare are, first, the diversification of qualifications for teaching infants and toddlers with disabilities, and second, the lack of education and training opportunities for disability integrated childcare teachers. Third, they are faced with admission criteria that is inconsiderate of the childcare facility, and fourth, the therapeutic importance for children with disabilities is overlooked. The institutional measures to improve the quality of disability integrated childcare are: first, reforming childcare programs to strengthen professionalism; second, establishing an integrated childcare advisory system linked to cooperative institutions, industries and government; and third, establishing customized integrated childcare operation standards.&#x0D; Conclusions This study is meaningful in that it suggests institutional measures to improve the quality of integrated childcare for infants and toddlers with disabilities through the voices of childcare teachers and early childhood specialists. It recommends further research that combines a qualitative study that conveys various voices of integrated childcare and a survey on the operational and physical environment to improve the quality of integrated childcare.

Turner’s Syndrome – genetic, diagnostic methods and clinical treatment

Introduction : Turner syndrome (TS) is one of the most common genetic disorders affecting approximatley 1 in 2,000-25000 live-born girls. TS is the result of complete oraz partial monosomy of the C chromosome. About half have monosomy X (45,X) and 5-10% have duplication (isochromosome) of the long arm of one X (46,X,i(Xq)). Most of the rest have mosaicism.(1) The aim of the study: The purpose of this review paper is to present the observations regarding this disease, including epidemiology, diagnosis and detailed examination of the individual needs of the patient affected by the disease. Matrials and methods: This review was based on available data collected in the PubMed database and Google Scholar web serach engine, using key words: Turner’s syndrome, diagnosis of Turner Syndrome, sex chromosome aneuploidies Summary: The article draws attention to the complexity of Turner syndrome, the variety of symptoms and the progress in the diagnosis and therapy of this disease. Early diagnosis, specialist care and modern therapeutic methods have a positive impact on the quality of life of TS patients. Future studies of molecular mechanisms and therapeutic efficacy may improve the care of patients affected by this rare disease.

Early Childhood Practitioners’ Perceptions of Children’s Risky Play Based on Childhood and Present Practice: A Questionnaire Survey in Japan

AbstractSimilar to countries in Europe and the Americas, risky play is a feature in Japanese early childhood education and care. This study investigated the perceptions and practices of Japanese early childhood education specialists with respect to risky play in order to ascertain whether their childhood experiences influenced their attitudes toward preschoolers’ risky play. Data were collected from a survey, and findings showed that childhood experiences influenced respondents’ practices regarding restricting risky or unsafe play. Among the various types of risky play, play at great heights received the most references regarding both childhood play and current activity restrictions. The research concluded that 1) regular and ongoing discussions among practitioners are crucial given their diverse experiences and the disparity of perceived risks between players and supervisors; 2) policy is required to provide children with rich experiences of risky play because of insufficient opportunities in their early childhood environments. Overall, the research highlights the importance of cultural and environmental backgrounds in practitioners’ perception of risky play.

O-174 The transition from fertility to maternity care services - a Royal College of Nursing publication

Abstract Study question Is there a need for guidance for nurses and midwives involved in the delivery of care for patients transitioning from fertility service to maternity services. Summary answer There is a potential knowledge gap that exists in the transition of care from fertility to maternity services. What is known already Once a patient becomes pregnant through fertility treatment in the UK, they are usually discharged out into NHS maternity care services via their general practitioner. This means that the maternity service staff are often unaware of the time it has taken to conceive, fertility treatments and procedures, fertility medications and emotional trauma that the patient has been through already and may not be aware of some of the complexities surrounding the fertility treatment journey. Study design, size, duration A project group of 14 key contributors was invited to be part of the publication that included fertility nurses, midwives, early pregnancy specialist nurses and patient representative members. An initial literature review took place and each person contributed from their specialist area. The project to produce the guidance took 9 months of planning, reviewing and meeting to discuss content with a final publication in September 2022. Participants/materials, setting, methods An initial literature review of the project subject did not highlight any existing research or publications in this area. A forum governance bid was submitted to produce a 45 page online resource aimed at fertility nursing staff, early pregnancy care staff and maternity services staff. The key project team contributed from their specialist areas and was reviewed by stakeholder groups. Main results and the role of chance Pregnancy following fertility treatment can be an exciting, challenging and anxious time for expectant parents. This projects aim was to primarily raise awareness of possible pathways of care for women and others (their partners/support networks) as they travel through fertility treatment and pregnancy, and how they can best be supported by the health care professionals they encounter along their journey. A 45 page online resource was produced and disseminated to fertility, early pregnancy and maternity staff via stakeholder groups and a webinar to launch the publication. Limitations, reasons for caution No limitations identified. The publication is available for all staff working in all three areas and provided guidance for all patient pathways including those from the LGBTQIA community. Wider implications of the findings No wider implications. Trial registration number Not applicable